ProjectSummary PatientswithCOPDhaveahighburdenofillnessandpoorqualityoflife.Despiteclearevidencethatsuch patientsfrequentlylackengagementinhealth-promotingbehaviorsandtendtode-valuefuturehealth consequences,almostnoworkhasinvestigatedwhetherthesepatientsmakepredictiveerrorsaboutfuture healthstatesnorinvestigatedtheassociationofsucherrorsonfuturehealth-relatedqualityoflife(HRQL).The proposedstudy?sbroadobjectiveistoimprovetheoutcomesofpatientswithCOPD.Thecandidate?s completedNHLBIF32-fundedstudyofpatientswithsmoking-associatedpulmonarydiseasesgenerateda conceptualframeworkthatformsthefoundationfortheproposedwork.Shehascontinuedtopreparefor scientificindependencethroughanNHLBIK12thatexplorestheacceptabilityandcompetencyofspecific attributesofphysician-patientcommunication(e.g.,choicearchitectureandtheuseofbeneficentdeception). Theproposedstudybuildsuponthesefindingsandseeksto1)assesstheaccuracywithwhichpatientswith severeCOPDpredicttheirfuturehealthstates,2)evaluatetherelationshipbetweenaccuracyofexpectations andpatient-reportedHRQL,and3)explorehowpatientswithdifferingexpectationsandpredictiveaccuracy generatetheirpredictionsandengageinprospection.Thestudywillinvolvealongitudinalprospectivecohort studyenrolling207patientswithsevereCOPD.Participantswillcompletebaselinemeasurementsofindividual characteristics(selectedfrompreliminarydataandapplicabletheories)andmeasuresofHRQL.Participants will,atthetimeofenrollment,providepredictionsoftheirdyspneaandemotionalsymptomsfor3and12 monthsinthefuture.Eachpatient?saccuracywillbedeterminedbycomparinghisorherindividualpredictions toexperiencedsymptomsatthesefollow-upintervals.Completionofthisresearchwillbuilduponthe candidate?spasttraininganduninterruptedNHLBIsupport,whichincludesaMastersinHealthPolicy ResearchobtainedwithNHLBIT32support,andF32andK12periods,andwillprovidetheexperience, education,andmentorshiptoallowthecandidatetobecomeafullyindependentinvestigator.Thecandidate?s rigoroustrainingplan,focusedonobtainingadvancedskillsinbehavioralscienceandpatient-centered outcomesresearchandexpertiseinprospectivestudies,willallowhertosubmitsuccessfulR01orPCORI applicationstestinginterventionsdevelopeddirectlyfromtheresultsofthiswork.Thecandidate?sprimary mentor,co-mentor,collaborators,andadvisorswillensureadherencetotheproposedtimelineandgoalsand provideasupportiveenvironmentforhertodevelopanindependentresearchcareerinvestigatingdecision interventionsthatimprovehealthoutcomesamongpatientswithCOPD.